DESCRIPTION (Adapted from candidate's abstract): This application describes an integrated 5-year training program of didactic study, research mentoring, and research studies focusing on gender identity and psychosexual development in children with major genital birth defects. The long-term objectives include the design of a comprehensive, data-driven, surgical/psychiatric approach to these children's psychosexual development, beginning at birth. Genital malformations are the most common human birth defects, especially those involving the phallic structure. The focus of this project will be children born with such major malformations of the penis that it cannot be reconstructed into a functional penis. The seriousness of these genital defects, thus, traditionally has led to a medical-surgical decision to reassign the sex-of-rearing of these children at birth; that is, 46 XY boys are castrated at birth and surgically reconstructed from male to female and reared as girls. The candidate's extensive experience as a pediatric urologist and now as a child and adolescent psychiatrist working with these children spurred his awareness of the paucity of data on the long-term effects of such sex-reassignment. The specific aims of the research plan are to determine if gender identity formation and psychosexual development are normal in children with genital anomalies severe enough to lead to sex-reassignment male to-female--at birth from the genetic 46 XY sex. The candidate will use validated instruments for gender identity and psychosexual development as well as more general psychiatric interviews. Matched female and male surgical control patients who are not sex-reassigned and matched female and male peer controls will be assessed. In addition, the study will identify the psychosexual developmental obstacles and hurdles the sex- reassigned children and the surgical control children endure. The results of these studies should lead to more rational, research-informed, surgical and psychiatric approaches to these children and their families.